How to Prepare for a Case

Andrew Jensen, MD, MBE | Elizabeth Dennis, MD | Cory Smith, MD

October 28, 2020


You made it. After all those hours of holding a retractor as a medical student, seeing patients in the ER, and discharging patients on the floor, you finally made it to the operating room. The lights are hot. The steel is cold. Now what? Without proper preparation, this much anticipated moment can be overwhelming and anxiety-inducing. However, appropriate preoperative planning can make this experience much more enjoyable.

1Know Anatomy. Know Anatomy. Know Anatomy.

You cannot operate if you do not know the anatomy. This is the first step in preparation, plain and simple. Fixation principles do not matter if you cannot safely get to the fracture. Tenodesis screws are pointless if not placed in the correct spot. You have to know the pertinent anatomy of EVERY case before you can do anything else. There are numerous ways to accomplish this whether it is opening the old school anatomy atlas book or using a new virtual anatomy dissection software.

2Know The Steps of Routine Procedures

One of the ways that you can make the operating room a much more enjoyable place is to know the steps of predictable procedures cold before the case. One reason chief residents and fellows can detect that irregularity at the fracture site or the small tear in the meniscus through the scope is that they are not thinking about the steps to place a rod or perform a diagnostic arthroscopy. Once this becomes routine, it frees your mind to be able to devote attention to details that make competent surgeons into proficient surgeons.

3Know Your Tools

This should not be the first step in your preparation, but it is vital to know your equipment and know it well. Whether it is a prosthesis, plate, anchor, or even a stitch, knowing what equipment you will need and all of its intricacies is the responsibility of the surgeon. This could mean simply reading a technique guide or even using the equipment in a lab before the case, but it is your responsibility to know the equipment and know it well.

4Use All Your Resources

It’s 2020. Google it. I obviously kid, but the internet has become an incredible resource for preoperative planning. Whether it is textbooks, surgical technique guides or papers, animations, or instructional videos, there is no shortage of reliable resources that you can use to help prepare for almost any case you may encounter. One of the most valuable resources is the AAOS Orthopedic Video Theatre that has over 1200 peer reviewed videos with technique videos and lectures. You can check it out here. Find a reliable source or two to prepare for cases and develop a routine that you can use to prepare effectively and efficiently.

5Talk to Your Attending

It seems obvious, but this step cannot be overlooked. There will be attendings that appreciate or even require this step more than others. However, discussing the case with your attending can not only help you make your preoperative plan but also show the initiative that makes our attendings more likely to hand over the case. Be humble. Ask questions. Learn.

6Do the Case Before You Do the Case

Once you have your preoperative plan formulated, one of the most effective ways to improve performance is mental rehearsal or meditation before actually performing the surgery. Many talented surgeons will tell you that difficult cases have already been performed in their mind tens or hundreds of times before they ever make the incision. This helps them anticipate the potential snags and complications and perform the mental gymnastics routine often times required in difficult surgery. There is no shortage of published material discussing the benefits of meditation and mental rehearsal in athletics, music, and surgery. Take a moment. Take a breath. Find a quiet space. Do the case step by step in your head. Then go operate and have fun!



DISCLOSURES: Dr. Dennis This individual reported nothing to disclose Dr. Jensen AAOS: Board or committee member Dr. Smith This individual reported nothing to disclose.

Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.


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